Identifying and Managing Intraoperative Arrhythmia: A Multidisciplinary Operating Room Team Simulation Case

Abstract

IntroductionResuscitation of a critically ill patient is challenging for both novice learners and experienced health care providers. During a critical event, not only is it important to identify the correct underlying diagnosis, it is equally crucial that the appropriate Advance Cardiac Life Support algorithm, medications, and defibrillator modality are implemented. This scenario features a 56-year-old female who presents for excisional biopsy of an inguinal lymph node to evaluate lymphadenopathy concerning for lymphoma. Intraoperatively, she goes into cardiopulmonary arrest. Participants must identify and manage three different scenarios: (1) ventricular fibrillation, (2) unstable ventricular tachycardia, and (3) bradycardia, including the use of the defibrillator.MethodWeekly simulation sessions were conducted in the in situ simulation operating room at Massachusetts General Hospital. Surgical residents, anesthesiology residents, nurses, and surgical technicians participated in a multidisciplinary operating room team. Each approximately 60-minute session included an orientation, the case, and the debriefing. Equipment included a simulation operating room with general surgery supplies, general anesthesia equipment, a high-fidelity SimMan patient simulator, a code cart, and a defibrillator.ResultsNinety-one multidisciplinary participants completed this scenario from September to December 2015. Participants reported that the scenario was applicable to their clinical practice (96%), promoted teamwork skills (88%), and encouraged interprofessional learning (94%).DiscussionIntraoperative cardiac arrest is a devastating event that can result in poor patient outcomes if the care team is not thoroughly prepared for crisis management. This simulation case scenario was implemented to train multidisciplinary learners in the identification and management of such an event.

Pediatric intraoperative cardiopulmonary arrests: A survey to evaluate if Medical Emergency Teams are utilized in pediatric operating rooms

“…Simulation for perioperative staff was also implemented to further optimize the code response. As reported by Wongsirimeteekul, in situ simulations of intra‐operative CA involving surgical residents, anesthesiology residents, nurses, and surgical technicians indicated that the practice promoted teamwork skills and encouraged interprofessional learning 10 …”

“…As reported by Wongsirimeteekul, in situ simulations of intra-operative CA involving surgical residents, anesthesiology residents, nurses, and surgical technicians indicated that the practice promoted teamwork skills and encouraged interprofessional learning. 10 A recent study from Wake Up Safe evaluated pediatric perioperative cardiac arrest and showed the majority of anesthesia-related CA was due to cardiovascular and respiratory causes. 2 The most common reasons that led to cardiovascular CA included arrythmia (33%), primary cardiac failure (19%), and hemorrhage (18%), while respiratory causes included airway obstruction (43%), and inability to intubate or ventilate (11%).…”

Evaluating the response of medical emergency teams to operating room code events in a children’s hospital

“…21 In their evaluation of 263 anesthesiologists participating in two simulated perioperative crises, including cardiac arrest, Weinger et al found gaps in participants' technical and non-technical performance. 21 In their weekly assessment of a simulated intraoperative cardiopulmonary arrest scenario using 91 multidisciplinary participants, Wongsirimeteekul et al 22 reported that the mock code was overwhelmingly applicable to clinical practice, encouraged interprofessional learning, and promoted teamwork. Holzman et al's study, 23 involving 68 anesthesiologists in a 2.5-month training course, rated their performance during a simulated OR code as good, increasingly so in direct correlation with their years of practice experience.…”

Pengelolaan Anestesi pada Pasien yang dilakukan Eksisi Tumor Medula Spinalis Servikal 2-3 dengan Ventrikel Ekstra Sistole

“…Pada pasien ini dilakukan pemeriksaan echocardiography untuk menilai apakah ada kelainan struktural dan penurunan ejection fraction, sehingga pada pasien ini sebaiknya dilakukan pemerksaan holter monitoring untuk menilai berapa kali VES muncul dalam 24 jam dan untuk menentukan apakah tatalaksana cukup dengan medical treatment atau memerlukan tindakan ablasi ventrikel ekstrasistol. [9][10][11][12] Tatalaksana ventrikel ekstrasistol dapat dilakukan dengan evaluasi nyeri. Analgetik yang ideal untuk pasien neuroanestesi tidak boleh menyebabkan depresi pernapasan maupun mempengaruhi tekanan intrakranial (TIK) dan cerebral perfusion pressure (CPP).…”